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Massachusetts rates for HCPCS L4030

Replace quadrilateral socket brim, custom fitted

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$248.52 / $248.52 / $248.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.52 / $273.93 / $396.78
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.91 / $941.10 / $3,602.35
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.50 / $433.11 / $555.47
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$329.00 / $329.00 / $977.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$329.00 / $418.05 / $477.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$348.85 / $348.85 / $856.50
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$460.52 / $460.52 / $483.55
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$361.38 / $361.38 / $361.38
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,499.62 / $3,602.35 / $3,602.35
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.64 / $304.04 / $555.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.50 / $304.04 / $555.47